Provider Demographics
NPI:1588627871
Name:DOWNSTATE PHYSICAL THERAPY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:DOWNSTATE PHYSICAL THERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MAYOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-609-4797
Mailing Address - Street 1:PO BOX 15488
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33318-5488
Mailing Address - Country:US
Mailing Address - Phone:954-609-4797
Mailing Address - Fax:954-423-3283
Practice Address - Street 1:10575 NW 11TH CT
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-6563
Practice Address - Country:US
Practice Address - Phone:954-609-4797
Practice Address - Fax:954-423-3283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15565225100000X
FL15798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty